Persistent ischiorectal fistula secondary to rectal extrusion of posterior vaginal mesh: Case report.

INTRODUCTION AND HYPOTHESIS: Vaginal mesh has been used for years to try to improve the results of pelvic organ prolapse surgery, but current evidence does not confirm this improvement and instead describes serious and frequent adverse events. CLINICAL CASE: 64-year-old patient with rectal extrusion of posterior vaginal mesh placed 8 years earlier, and persistent left ischiorectal fistula refractory to surgery. She required 5 surgeries, carried out jointly between gynecology and general surgery, to solve, firstly, the bilateral perianal abscess secondary to extrusion of the posterior vaginal mesh into the rectum and then the persistent left ischiorectal fistula, despite the removal of the material prosthetic. Finally, the fistula was solved by injection of platelet-rich plasma. CONCLUSIONS: Vaginal mesh complications often need a multidisciplinary approach, and treatment may require multiple approaches and more than one surgical procedure. In the case of a persistent fistula refractory to surgery, after removing the mesh, non-invasive regenerative therapies that promote vascular growth and tissue regeneration could be considered such as platelet-rich plasma.

The association between SARS-CoV-2 infection and preterm delivery: a prospective study with a multivariable analysis.

BACKGROUND: To determine whether severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2, the cause of COVID-19 disease) exposure in pregnancy, compared to non-exposure, is associated with infection-related obstetric morbidity. METHODS: We conducted a multicentre prospective study in pregnancy based on a universal antenatal screening program for SARS-CoV-2 infection. Throughout Spain 45 hospitals tested all women at admission on delivery ward using polymerase-chain-reaction (PCR) for COVID-19 since late March 2020. The cohort of positive mothers and the concurrent sample of negative mothers was followed up until 6-weeks post-partum. Multivariable logistic regression analysis, adjusting for known confounding variables, determined the adjusted odds ratio (aOR) with 95% confidence intervals (95% CI) of the association of SARS-CoV-2 infection and obstetric outcomes. MAIN OUTCOME MEASURES: Preterm delivery (primary), premature rupture of membranes and neonatal intensive care unit admissions. RESULTS: Among 1009 screened pregnancies, 246 were SARS-CoV-2 positive. Compared to negative mothers (763 cases), SARS-CoV-2 infection increased the odds of preterm birth (34 vs 51, 13.8% vs 6.7%, aOR 2.12, 95% CI 1.32-3.36, p = 0.002); iatrogenic preterm delivery was more frequent in infected women (4.9% vs 1.3%, p = 0.001), while the occurrence of spontaneous preterm deliveries was statistically similar (6.1% vs 4.7%). An increased risk of premature rupture of membranes at term (39 vs 75, 15.8% vs 9.8%, aOR 1.70, 95% CI 1.11-2.57, p = 0.013) and neonatal intensive care unit admissions (23 vs 18, 9.3% vs 2.4%, aOR 4.62, 95% CI 2.43-8.94, p <  0.001) was also observed in positive mothers. CONCLUSION: This prospective multicentre study demonstrated that pregnant women infected with SARS-CoV-2 have more infection-related obstetric morbidity. This hypothesis merits evaluation of a causal association in further research.

Tratamiento insulínico, requerimientos de insulina y resultados perinatales en una cohorte de embarazadas con diabetes tipo 1 / Insulin treatment, insulin requirements and perinatal outcomes in a pregnancy cohort with type 1 diabetes

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Obstetric Outcomes of SARS-CoV-2 Infection in Asymptomatic Pregnant Women.

Around two percent of asymptomatic women in labor test positive for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in Spain. Families and care providers face childbirth with uncertainty. We determined if SARS-CoV-2 infection at delivery among asymptomatic mothers had different obstetric outcomes compared to negative patients. This was a multicenter prospective study based on universal antenatal screening for SARS-CoV-2 infection. A total of 42 hospitals tested women admitted for delivery using polymerase chain reaction, from March to May 2020. We included positive mothers and a sample of negative mothers asymptomatic throughout the antenatal period, with 6-week postpartum follow-up. Association between SARS-CoV-2 and obstetric outcomes was evaluated by multivariate logistic regression analyses. In total, 174 asymptomatic SARS-CoV-2 positive pregnancies were compared with 430 asymptomatic negative pregnancies. No differences were observed between both groups in key maternal and neonatal outcomes at delivery and follow-up, with the exception of prelabor rupture of membranes at term (adjusted odds ratio 1.88, 95% confidence interval 1.13-3.11; p = 0.015). Asymptomatic SARS-CoV-2 positive mothers have higher odds of prelabor rupture of membranes at term, without an increase in perinatal complications, compared to negative mothers. Pregnant women testing positive for SARS-CoV-2 at admission for delivery should be reassured by their healthcare workers in the absence of symptoms.

Corticoides antenatales e incidencia de distrés respiratorio del recién nacido en las cesáreas programadas del pretérmino tardío y término precoz / Antenatal corticosteroids and incidence of neonatal respiratory distress after elective caesarean section in late preterm and term neonates

Introducción: El nacimiento por cesárea programada de los recién nacidos pretérmino tardíos y a término precoces aumenta el riesgo de distrés respiratorio. La administración de corticoides antenatales en estos casos podría disminuir el distrés respiratorio y su gravedad. Objetivos: Determinar la repercusión del uso de corticoides antenatales en las cesáreas programadas en el distrés respiratorio del recién nacido de 35 a 38 + 6 semanas de edad gestacional (SEG). Pacientes y métodos: Estudio analítico retrospectivo en un hospital de tercer nivel, de las cesáreas de 35+0 a 38+6 SEG desde enero de 2013 hasta abril de 2017. Recogida de datos de las historias clínicas de las gestantes y recién nacidos tras la instauración de un nuevo protocolo de administración de una dosis de betametasona a las gestantes con cesáreas programadas de esta edad gestacional. Análisis en 2 subgrupos: recién nacidos pretérmino (RNPT) 35-36 SEG y a término (RNT) 37-38 SEG. Resultados: En este periodo se realizaron 208 cesáreas programadas. Se administraron corticoides en 97 casos (46,6%). El porcentaje de distrés fue mayor en el grupo de cesáreas programadas de RNPT comparado con los RNT (29 vs. 8,8%; p < 0,001) y entre los RNT fue mayor a menor edad gestacional. Entre las cesáreas programadas tratadas y no tratadas con corticoides no se encontraron diferencias significativas en cuanto al desarrollo de distrés respiratorio (RNPT 30 vs. 30%; p = 1; RNT 9,1 vs. 6.9%; p = 0,6). Conclusiones: En este estudio no se encontraron diferencias estadísticamente significativas a favor del beneficio de la administración de una dosis antenatal de betametasona en la disminución del distrés respiratorio del recién nacido en las cesáreas programadas de 35+0 a 38+6 SEG. El retraso en la indicación de cesáreas programadas, siempre que sea posible, podría contribuir a disminuir la incidencia de distrés respiratorio

Introduction: Birth by elective caesarean section in late preterm and early term newborn increases the risk of respiratory distress. Administration of antenatal corticosteroids in these cases could reduce the respiratory distress and its severity. Objectives: To determine the influence of antenatal corticosteroids use in elective caesarean sections in the respiratory distress of the newborn from 35+0 to 38+6 weeks of gestational age. Patients and methods: Retrospective analytical study of caesarean sections from 35+0 to 38+6 gestational age was conducted in a tertiary hospital from January 2013 to April 2017. Data were collected from medical records of pregnant women and newborns after an implementation of new protocol of betamethasone administration to these elective caesarean sections. Analysis was performed on 2 newborn subgroups: preterm newborn (PTN) 35-36 gestational age and term (TN) 37-38 weeks. Results: A total of 208 elective caesarean sections were performed in the study period. Corticosteroids were administered in 97 (46.6%) of cases. The percentage of respiratory distress was higher in the group of preterm newborn compared to term newborn (29% vs. 8.8%, P<.001) and in term newborn higher at a lower gestational age. Between treated with corticosteroids or not, no significant differences were found in the treated and non-treated in the development of respiratory distress (PTN 30 vs. 30%, TN 9.1 vs. 6.9%, P=.6). Conclusions: No statistically significant differences were found in this study in favour of the administration of an antenatal dose of betamethasone in the reduction of respiratory distress in the elective caesarean sections from 35+0 to 38+6 gestational age. The delay in the indication of elective caesarean sections, whenever possible, could help reduce the incidence of newborn respiratory distress

Normalized second and fourth finger lengths in male and female partners and IVF cycle outcomes.

RESEARCH QUESTION: Hox genes are involved in limb formation during normal embryological development. Their modulation by circulating maternal oestrogens and androgens determines the length of the second and fourth fingers of the adult hand. Do these same intrauterine hormone levels also determine fertility outcomes in the adult? DESIGN: To study the association between the length of the second and fourth fingers of both partners undergoing IVF (as a surrogate of their previous intrauterine exposure to oestrogens and androgens) with treatment outcome after IVF, data corresponding to 256 IVF cycles were analysed. Finger length was normalized to the individual height. RESULTS: In the female partner, a longer normalized second finger length of the left (2DLN) hand, reflecting a high intrauterine exposure to oestrogens, was independently and significantly (P = 0.011) associated with obtaining at least one top-quality embryo in a multivariate model. Conversely, in the male partner a longer normalized fourth finger length of the left hand (4DLN), reflecting a high intrauterine exposure to androgens, was independently and significantly (P = 0.032) associated with obtaining at least one top-quality embryo in the same multivariate model. In the female partner, 2DLN was inversely and significantly (P = 0.01) associated with achievement of pregnancy. CONCLUSIONS: Intrauterine exposure to high levels of oestrogens and androgens in females and males, respectively, predisposes to the production of higher-quality embryos under in-vitro conditions during adulthood. Paradoxically, this also seems to result in a lower pregnancy rate.

[Antenatal corticosteroids and incidence of neonatal respiratory distress after elective caesarean section in late preterm and term neonates]. / Corticoides antenatales e incidencia de distrés respiratorio del recién nacido en las cesáreas programadas del pretérmino tardío y término precoz.

INTRODUCTION: Birth by elective caesarean section in late preterm and early term newborn increases the risk of respiratory distress. Administration of antenatal corticosteroids in these cases could reduce the respiratory distress and its severity. OBJECTIVES: To determine the influence of antenatal corticosteroids use in elective caesarean sections in the respiratory distress of the newborn from 35+0 to 38+6 weeks of gestational age. PATIENTS AND METHODS: Retrospective analytical study of caesarean sections from 35+0 to 38+6 gestational age was conducted in a tertiary hospital from January 2013 to April 2017. Data were collected from medical records of pregnant women and newborns after an implementation of new protocol of betamethasone administration to these elective caesarean sections. Analysis was performed on 2newborn subgroups: preterm newborn (PTN) 35-36 gestational age and term (TN) 37-38 weeks. RESULTS: A total of 208 elective caesarean sections were performed in the study period. Corticosteroids were administered in 97 (46.6%) of cases. The percentage of respiratory distress was higher in the group of preterm newborn compared to term newborn (29% vs. 8.8%, P<.001) and in term newborn higher at a lower gestational age. Between treated with corticosteroids or not, no significant differences were found in the treated and non-treated in the development of respiratory distress (PTN 30 vs. 30%, TN 9.1 vs. 6.9%, P=.6). CONCLUSIONS: No statistically significant differences were found in this study in favour of the administration of an antenatal dose of betamethasone in the reduction of respiratory distress in the elective caesarean sections from 35+0 to 38+6 gestational age. The delay in the indication of elective caesarean sections, whenever possible, could help reduce the incidence of newborn respiratory distress.

¿Está la morfometría de las manos relacionada con la edad de la menarquia? / Is the morphometry of the hands related to the age of menarche?

Antecedentes: La relación entre la longitud del segundo y cuarto dedo de las manos (ratio D2:D4) se ha relacionado con la exposición intrauterina a los andrógenos. Se define un patrón androgénico cuando la longitud del cuarto dedo es superior a la del segundo y el cociente es menor de 1. Este ratio se pone en relación con aspectos del desarrollo y la función reproductiva de los individuos, tales como la resistencia al ejercicio físico, el autismo, la concentración de espermatozoides o la esterilidad. Objetivo: Establecer asociación entre la ratio D2:D4 con la edad de la menarquia. Método: Estudio transversal descriptivo sobre una población no seleccionada de 188 mujeres. Se recogen las longitudes de los dedos con un calibre digital, desde una imagen en papel obtenida con un escáner. El análisis estadístico se realizó mediante el test de correlación de Pearson, considerando significativo un valor de p<0,05. Resultados: El análisis de correlación entre los parámetros morfométricos de las manos y la edad de la menarquia, presentó relación estadísticamente significativa y directamente proporcional con la longitud del cuarto dedo en ambos manos. Conclusión: Los resultados obtenidos indican una relación entre el perfil androgénico de la morfometría de las manos y el retraso de la menarquia. Este hecho constituye un inicio en la búsqueda de relaciones entre las características morfométricas de las manos y condiciones clínicas, que podrían estar influenciadas por la exposición androgénica durante el periodo fetal.

Background: The relationship between the length of the second and fourth fingers of the hands (ratio D2:D4) has been associated with intrauterine exposure to androgens. The androgenic pattern is defined when the length of the fourth finger is higher than the second, and the ratio is lower than 1. This ratio is set in relation to aspects of development and reproductive function of individuals, such as resistance to physical exercise, autism, sperm concentration or sterility. Aims: Find relationship between the ratio D2:D4 with age of menarche. Methods: Descriptive cross-sectional study in an unselected population of 188 women. The finger lengths with a digital caliper is collected from a paper image obtained by a scanner. Statistical analysis was perfomed using the Pearson correlation coefficient, with significant value p<0.05. Results: Correlation analysis between the morphometric parameters of the hands and the age of menarche, showed statistically significant and directly proportional to the length of the fourth finger on both hands relationship. Conclusion: The results indicate a relationship between the androgenic pattern morphometry hands and late menarche. This is a start in the search for relationships between the morphometric characteristics of the hands and clinical conditions that might be influenced by androgen exposure during fetal period.

The validity of ultrasonography in predicting the outcomes of labour induction.

PURPOSE: To analyse the validity of ultrasonography in predicting the outcomes of labour induction, compared with Bishop score (BS), and to design a predictive model including ultrasound and clinical variables. METHODS: In this prospective, observational study of 151 women who underwent induction of labour, an endovaginal ultrasound was performed to determine cervical length (CL), the wedging pattern and the presence of dilatation and funnel. Foetal head-perineum distance (FHPD) was measured by transperineal ultrasound. Vaginal examination was performed to calculate BS and to determine whether cervical ripening was needed. The outcome variable was the method of delivery. RESULTS: Caesarean section was performed in 30.5 % of cases. CL (26.1 vs. 31.4) and FHPD (44.7 vs. 51.3) were lower in the vaginal delivery group. The area under the curve obtained for FHPD (0.734) was greatest, followed by CL (0.663) and BS (0.678). The proposed model resulted in correct predictions in 82.8 % of cases, with 15 % false positives. CONCLUSIONS: The FHPD and the CL are useful in predicting the result of the induction labour comparable to Bishop score. Using ultrasound scan is significantly better tolerated than vaginal exam. The predictive model selects women who undergo induction having a risk of caesarean section equivalent to spontaneous delivery.

Valores de referencia y cribado universal de la disfunción tiroidea en la mujer gestante / Reference values and universal screening of thyroid dysfunction in pregnant women

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Urinary incontinence during pregnancy and postpartum. Associated risk factors and influence of pelvic floor exercises.

OBJECTIVES: To determine the prevalence of urinary incontinence (UI) before pregnancy, in the third trimester and postpartum. To analyze its influence on quality of life and associated potential risk factors and the efficacy of pelvic floor exercises. METHODS: Prospective study in 413 pregnant women. The modified ICIQ-SF incontinence questionnaire was given to the pregnant women at the end of the third quarter. This questionnaire was administered by telephone at 3 and 6 months postpartum. The influence of several risk factors for UI in pregnancy and postpartum were analyzed. Patients with persistent UI at 6 months postpartum were trained to do pelvic floor exercises. RESULTS: Patients with UI before pregnancy were excluded from the study. UI in the third trimester was 31%. Analyzed risk factors did not condition a higher percentage of UI. Prevalence of UI was 11.3% at 3 months postpartum and 6.9% at 6 months. 70% of the incontinent patients already had it during pregnancy and it appeared de novo post-delivery in 30% of the patients. Prevalence of UI after delivery was higher in women with UI in pregnancy and lower in caesarean cases. Most women improved with pelvic floor exercises. CONCLUSIONS: Analysed risk factors did not significantly increase UI in pregnancy. Prevalence of UI after delivery is higher in women with UI in pregnancy and lower in caesarean cases. Postpartum pelvic floor exercises for three months in patients with persistent stress UI at 6 months postpartum clearly improved the degree of continence.

Incontinencia urinaria en embarazo y postparto. Factores de riesgo asociados e influencia de los ejercicios del suelo pélvico / Urinary incontinence during pregnancy and postpartum. Associated risk factors and influence of pelvic floor exercises

OBJETIVO: Determinar la prevalencia de incontinencia urinaria (IU) previa a la gestación, en el tercer trimestre y en el postparto. Analizar su influencia en la calidad de vida, los posibles factores de riesgo y la eficacia de los ejercicios del suelo pélvico. MÉTODOS: Estudio prospectivo a 413 gestantes. Se entregó el cuestionario de incontinencia ICIQ-SF modificado a las gestantes al final del tercer trimestre y a los 3 y 6 meses postparto. Se analizó la influencia de varios factores de riesgo de IU en el embarazo y en el postparto. Las pacientes con persistencia de IU a los 6 meses del parto fueron instruidas para realizar ejercicios de suelo pélvico. RESULTADOS: Las pacientes con IU previa a la gestación fueron excluidas. La prevalencia de incontinencia en el tercer trimestre en gestantes fue del 31%. Ningún factor de riesgo condicionó un mayor porcentaje de IU. La prevalencia de IU fue de 11.3 % a los tres meses del parto y del 6.9% a los 6 meses. De las pacientes incontinentes un 70% ya la sufría en el embarazo y en el 30% apareció de novo tras el parto. El porcentaje de IU postparto fue más elevado en mujeres con IU en la gestación y más bajo en aquellas con cesárea. La mayoría de las mujeres mejoraron con ejercicios de suelo pélvico. CONCLUSIONES: Ningún factor de riesgo aumenta el riesgo de IU en gestantes de forma significativa. La prevalencia de IU tras el parto es mayor en aquellas mujeres con IU en el embarazo y más baja en aquellas con cesárea. La mayoría de las puerperas mejoraron con ejercicios de suelo pélvico

OBJECTIVES: To determine the prevalence of urinary incontinence (UI) before pregnancy, in the third trimester and postpartum. To analyze its influence on quality of life and associated potential risk factors and the efficacy of pelvic floor exercises. METHODS: Prospective study in 413 pregnant women. The modified ICIQ-SF incontinence questionnaire was given to the pregnant women at the end of the third quarter. This questionnaire was administered by telephone at 3 and 6 months postpartum. The influence of several risk factors for UI in pregnancy and postpartum were analyzed. Patients with persistent UI at 6 months postpartum were trained to do pelvic floor exercises. RESULTS: Patients with UI before pregnancy were excluded from the study. UI in the third trimester was 31%. Analyzed risk factors did not condition a higher percentage of UI. Prevalence of UI was 11.3% at 3 months postpartum and 6.9% at 6 months. 70% of the incontinent patients already had it during pregnancy and it appeared de novo post-delivery in 30% of the patients. Prevalence of UI after delivery was higher in women with UI in pregnancy and lower in caesarean cases. Most women improved with pelvic floor exercises. CONCLUSIONS: Analysed risk factors did not significantly increase UI in pregnancy. Prevalence of UI after delivery is higher in women with UI in pregnancy and lower in caesarean cases. Postpartum pelvic floor exercises for three months in patients with persistent stress UI at 6 months postpartum clearly improved the degree of continence

Amniodrenaje repetido para el tratamiento de un polihidramnios grave / Repeated amniodrainage for the treatment of severe polyhydramnios

El polihidramnios, con una incidencia de 1/200 gestaciones, se define como el aumento de la cantidad de líquido amniótico y se asocia a un aumento de la patología perinatal. Se debe a una alteración del equilibrio que existe entre la producción y la eliminación del fluido. Se diagnostica mediante estudio ecográfico y se determina por métodos semicuantitativos. Durante el embarazo se puede realizar un estudio etiológico. El tratamiento va encaminado a disminuir el riesgo de complicaciones debidas a la hiperdistensión uterina, sobre todo el parto prematuro, y a adecuar la atención a los recién nacidos. Presentamos un caso de polihidramnios grave tratado mediante amniodrenaje repetido, producido por un seudohipoaldosteronismo, causa infrecuente de hidramnios y difícil de diagnosticar mediante el estudio prenatal habitual (AU)

The polyhydramnios, with an incidence of 1/200 pregnancies, defined as the increase in the amount of amniotic fluid, is associated with an increase in perinatal pathology. It is due to disruption of the equilibrium that exists between the production and removal of the fluid. It is diagnosed by ultrasound and is determined by semi-quantitative methods. During pregnancy can be An aetiological study may be made during pregnancy. The treatment is aimed at reducing the risk of complications due to uterine overdistensión, mainly pre-term birth, and appropriate care of the newborn. We report a case of severe polyhydramnios treated by repeated amniodrainage, produced by a pseudo-hypoaldosteronism, a rare cause, and difficult to diagnose by routine prenatal study (AU)